Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score

Post, Cathalijne; Kramer, Miranda C.A.; Smid, Ernst J.; Weide, H. L. van der; Kleynen, Catharina E.; Heesters, Mart A. A. M.; Verhoeff, J.

doi:10.1016/j.radonc.2018.10.034

Cited by 23 publications

(15 citation statements)

References 31 publications

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“…Analysis in a retrospective review has not shown any differences in OS after stereotactic or conventionally fractionated re-RT [35]. The similar outcome (mOS of 9.7 months) using conventional-, hypofractionated or SRS techniques was confirmed by another retrospective analysis of re-RT for recurrent malignant glioma [36]. The 9-month mOS with re-RT achieved in our patients with GTV median of 118 cm 3 [17,25,32].…”

Section: Discussionsupporting

confidence: 62%

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

Dobi

Darázs

Fodor

et al. 2020

Pathol. Oncol. Res.

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The aim of the present study was to evaluate the efficacy of re-irradiation (re-RT) in patients with advanced local relapses of glial tumours and to define the factors influencing the result of the hyper-fractionated external beam therapy on progression after primary management. We have analysed the data of 55 patients with brain tumours (GBM: 28) on progression, who were reirradiated between January 2007 and December 2018. The mean volume of the recurrent tumour was 118 cm 3 , and the mean planning target volume (PTV) was 316 cm 3 , to which 32 Gy was delivered in 20 fractions at least 7.7 months after the first radiotherapy, using 3D conformal radiotherapy (CRT) or intensity modulated radiotherapy (IMRT). The median overall survival (mOS) from the re-RT was 8.4 months, and the 6-month and the 12-month OS rate was 64% and 31%, respectively. The most important factors by univariate analysis, which significantly improved the outcome of re-RT were the longer time interval between the diagnosis and second radiotherapy (p = 0.029), the lower histology grade (p = 0.034), volume of the recurrent tumour (p = 0.006) and Karnofsky performance status (KPS) (p = 0.009) at the re-irradiation. Our low fraction size re-irradiation ≥ 8 months after the first radiotherapy proved to be safe and beneficial for patients with large volume recurrent glial tumours.

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Section: Discussionsupporting

confidence: 62%

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

Dobi

Darázs

Fodor

et al. 2020

Pathol. Oncol. Res.

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“…Both the original Combs score and its modi cation were further validated in an independent multi-centre cohort [21,29], con rming their prognostic utility in clinical practice. Researchers in Germany further pooled data in a multivariable model from 353 patients of recurrent/progressive HGG treated with salvage re-RT at various institutions to develop a novel reirradiation risk score (RRRS) based on a linear combination of initial histology, clinical performance status, and age into three prognostic groups which successfully predicted post-re-RT survival outcomes [20] and later found validation in another independent multicenter cohort [30]. In parallel, researchers from the National Institutes of Health developed a prognostic scoring system [19] in their small cohort of 31 patients with recurrent/progressive HGG treated with re-RT using three sub-scores de ned as independent factors (age, KPS, WHO grade, presence of symptoms); target control (tumor size, tumor location, presence of diffuse disease); and anticipated risk of toxicity risk (OAR location, OAR dose distribution, DFI).…”

Section: Resultsmentioning

confidence: 99%

High-dose Salvage Re-irradiation in Recurrent/progressive Adult Diffuse High-Grade Glioma: Development of a Novel Prognostic Scoring System

Gupta¹,

Maitre²,

Maitre³

et al. 2021

Preprint

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Purpose: Over the past two decades, high-dose salvage re-irradiation (re-RT) has been used increasingly in the multimodality management of adults with recurrent/progressive high-grade glioma (HGG). Several factors that determine outcomes following re-RT have been incorporated into prognostic models to guide patient selection. We aimed to develop a novel four-tiered prognostic model incorporating relevant molecular markers from our single-institutional cohort of patients treated with high-dose salvage re-RT for recurrent/progressive HGG. Methods: Various patient, disease, and treatment-related factors impacting upon survival following salvage re-RT were identified through univariate analysis. Each of these prognostic factors was further subdivided and assigned scores of 0 (good-risk), 1 (intermediate-risk), or 2 (high-risk) to create a composite prognostic scoring system. Scores from individual prognostic factors were added to derive the cumulative score (ranging from 0 to 16), with increasing scores indicating worsening prognosis. Results: A total of 111 patients with recurrent/progressive HGG treated with salvage high-dose re-RT constituted the study dataset. We could assign patients into four prognostic subgroups (A=15 patients, score 0-3); (B=50 patients, score 4-7); (C=33 patients, score 8-10); and (D=13 patients, score 11-16) with completely non-overlapping survival curves suggesting the good discriminatory ability of the proposed prognostic scoring system. Post-re-RT survival was significantly higher in Group A compared to groups B, C, and D, respectively (stratified log-rank p-value <0.0001). Conclusion: A novel four-tiered prognostic scoring system incorporating traditional factors as well as relevant molecular markers is proposed for selecting patients appropriately for high-dose salvage re-RT.

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“…Another study has suggested similar survival after re-RT when using standard RT compared with stereotactic techniques [28]. Another retrospective analysis of re-RT for recurrent malignant glioma has suggested that the median OS of 9.7 months does not differ among CFRT, HFRT, and SRS [34]. Similar trend can be found in earlier data showing that FSRT (37.5 Gy/15 fx) has similar median OS but significantly lower risk of radionecrosis compared to SRS (17 Gy) despite poorer prognostic factors in recurrent high-grade glioma (GBL in 59%) [35].…”

Section: Re-rt Alonementioning

confidence: 99%

“…However, their new prognostic group has critical drawback of not including MGMT methylation status because MGMT data were not available for many patients. Nonetheless, the Niyazi score group was validated in external cohorts of 121 patients with recurrent grade II, III, IV glioma which showed median OS of 14.6, 9.76, and 5.32 months for the prognostic group [34].…”

Section: Re-rt Alonementioning

confidence: 99%

Appraisal of re-irradiation for the recurrent glioblastoma in the era of MGMT promotor methylation

Kim

2019

Radiat Oncol J

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Despite recent innovation in treatment techniques and subsequently improved outcomes, the majority of glioblastoma (GBL) have relapses, especially in locoregional areas. Local re-irradiation (re-RT) has been established as a feasible option for recurrent GBL of all ages with safety, tolerability, and effectiveness both in survival and quality of life regardless of fractionation schedule. To keep adverse effects under acceptable range, cumulative dose limit in equivalent dose at 2 Gy fractions by the linear-quadratic model at α/β = 2 for normal brain tissue (EQD2) with narrow margin should be observed and single/hypofractionated re-RT should be undertaken very carefully to recurrent tumor with large volume or adjacent to the brainstem. Promising outcome of re-operation (re-Op) plus re-RT (re-Op/RT) need to be validated and result from re-RT with temozolomide/bevacizumab (TMZ/BV) or new strategy is expected. Development of new-concept prognostic scoring or risk group is required to select patients properly and make use of predictive biomarkers such as O(6)-methylguanine-DNA methyltransferase (MGMT) promotor methylation that influence outcomes of re-RT, re-Op/RT, or re-RT with TMZ/BV.

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Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score

Cited by 23 publications

References 31 publications

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

High-dose Salvage Re-irradiation in Recurrent/progressive Adult Diffuse High-Grade Glioma: Development of a Novel Prognostic Scoring System

Appraisal of re-irradiation for the recurrent glioblastoma in the era of MGMT promotor methylation

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